The full-scale pandemic world of H1N1 virus

By George Contreras / george@theklaxon.com / 12.06.2009

Updated on: 01.17.10 at 11:46 am

When the World Health Organization (WHO) announced this past summer that they were upgrading the pandemic level from 5 to 6 (the highest level), indicating that there was sustainable human-to-human transmission worldwide, what had not been discussed is that we were at this level for some time.

The public needs to realize that public health and other government agencies have been very careful in their announcements in order to avoid mass public panic.

Health care organizations, such as hospitals, have a responsibility and obligation to provide a safe environment for its staff, patients and visitors. If they are unable to provide uninterrupted operations, contingency plans must be activated.

Over the past ten years, there have been significant changes to industry standards regarding health care emergency management standards. The Joint Commission (a major regulatory organization responsible for the accreditation of over 16,000 health care organizations throughout the country) has modified (and some may say improved) its health care emergency management standards in recent years. Specifically, there was a 34 percent increase in health care emergency management standards from 2006 to 2008.

An area of concern arises because health care organizations are constantly being asked to “do more with less.” In addition to the proposed health care cuts, health care organizations get very little funding to carry out minimal preparedness activities that would ultimately prepare them to take care of its communities. New York State health care organizations (e.g. hospitals, clinics, nursing homes, etc) are no different and suffer these same challenges.

As an example, in New York City, the federal funding sources for hospital emergency preparedness have consistently decreased since 2002. Currently, each of the 63 NYC hospitals receives less than $100,000 (as core grants) from the New York City Department of Health and Mental Hygiene as part of its Hospital Emergency Preparedness Program (HEPP).

Given today’s economic stressors, this small amount of monies can only go so far in terms of keeping our hospitals prepared for the next disaster, either natural or man-made.

As an emergency management practitioner and educator, I strongly believe that there needs to be more investment in our health care organizations that provide a critical infrastructure asset to our society.

As an example, hospitals are not being given the tools to adequately prepare themselves for man-made disasters (e.g. September 11th terrorist attacks), natural disasters (e.g. SARS outbreak or pandemic influenza such as H1N1), or technological events or accidents (e.g. large hazardous materials spills).

There is a need for regulatory and other accrediting agencies to come together and work in a concerted effort to help organizations prepare themselves with creating duplicative standards. The overall funds are very limited. The emergency management standards are ever increasing and/ or changing. It would appear that health care organizations are striving to barely keep up with these ever-changing standards.

If health care organizations are unable to provide critical and basic services to the general population, the public health of all will be compromised. One very real example that highlights this deficiency is the now reality of a pandemic influenza with H1N1.

As per the health care organizations themselves, the consequences of surge capacity and resource management will be two of the largest obstacles in responding to these public health emergencies. From a planning perspective, health care organizations also struggle to constantly sustain its emergency preparedness efforts because of limited funds dedicated to preparedness efforts.

One has to remember that emergency or disaster management departments in hospitals are non-revenue generating areas that require time, effort and money to carry out their overall goals.

There needs to be a collaborative effort to resist these proposed health care cuts so that organizations can continue to provide the quality care that people expect. Parallel to that quality of care is the constant state of readiness for any event that may challenge its capabilities.

We also need to remember the critical role that the public plays in public health. Communities also need to do their part and prepare themselves in the event of an emergency or disaster. How many working parents will have to miss work if their children are not allowed to go to school because of forced closures?

The labor force will be hit very hard if all schools are closed. Researchers predict that a full-scale pandemic (e.g. at the 1918 scale) could result in 30 to 40 percent absenteeism at work. People need to understand that decisions surrounding public health measures are not as simple as they may appear.

During the initial wave, we saw a mild version of a pandemic. The number of deaths has been small when compared to the total population.

A similar “milder” outbreak was also seen during the last three major outbreaks in the 20th century. A much larger number of deaths was observed during the return of the virus in the fall of the same year. Now that we are experiencing the continuation of the pandemic, the public needs to do their part in order to protect the integrity of public health.

This challenge needs to be addressed as a collaborative effort by private and public sectors alike.

Given all of this information and the knowledge that we have not seen the last of the H1N1, why not work together and invite regulatory agencies as well as funding partners and see how all objectives can be met without compromising the public health of all (or maybe some) citizens? The time has definitely come for elected officials, private sector, health care organization leaders and the public to come together and brainstorm how to prepare for public health emergencies as we enter an era of tumultuous economic times in the years to come.

H1N1 is merely one example of natural disaster that will make our healthcare communities struggle to meet the increasing demands imposed on the health care system. We should take this real-life event as a “wake-up” call and realize that much works still needs to be done.